右美托咪定替代瑞芬太尼对甲状腺手术 全麻患者术后恶心呕吐的影响

目的 观察右美托咪定对甲状腺手术全麻患者术后恶心呕吐的影响。方法 选取我院2016年1月～2017年2月择期全麻甲状腺患者80例，随机分为两组，每组40例。D组给予右美托咪定，R组给予瑞芬太尼。观察患者入室时、插管前、插管后5 min、手术开始后5 min、手术开始后30 min、缝皮时、拔管后5 min的平均动脉压和心率。记录麻醉时间、手术时间、睁眼时间、拔管时间、及入PACU时的警觉镇静评分、术后疼痛评分、补救止吐和镇痛药物的使用。观察患者0～2 h、2～24 h内恶心呕吐发生情况。结果 T2～T7时D组HR低于R组（P＜0.05），两组间MAP差异无统计学意义（P＞0.05）。R组和D组患者手术时间、麻醉时间对比，差异无统计学意义（P＞0.05）。D组睁眼时间、拔管时间长于R组，D组OAA/S镇静评分低于R组（P＜0.05）；后2个时段，D组恶心发生率低于R组（P＜0.05）；止吐药使用率低于R组（P＜0.05）；两组术后呕吐发生率，差异无统计学意义（P＞0.05）。术后0～2 h疼痛VAS评分，两组差异无统计学意义（P＞0.05）；术后2～24 h，D组VAS评分低于R组；两组补救镇痛率无统计学意义（P＞0.05）。结论 对于甲状腺手术患者，麻醉诱导前右美托咪定负荷量1 μg，维持量0.3～0.5 μg/（kg·h）可有效降低术后恶心呕吐的症状，减少止吐药物的使用，改善术后镇痛效果。

Effect of Dexmedetomidine in Place of Remifentanil on Postoperative Nausea and Vomiting in General Anesthesia Patients Undergoing Thyroid Surgery

Abstract:Objective To observe the effect of dexmedetomidine on postoperative nausea and vomiting in patients undergoing thyroid surgery.Methods 80 cases of thyroid patients undergoing elective general anesthesia from January 2016 to February 2017 in our hospital were randomly divided into two groups with 40 cases in each group.Group D received dexmedetomidine and group R received remifentanil.Observe the mean arterial pressure and heart rate of the patient when entering the room,before the intubation,5 minutes after the intubation,5 minutes after the beginning of the surgery,30 minutes after the beginning of the surgery,when the skin is sutured, and 5 minutes after the extubation.The time of anesthesia,operation time,blinking time,extubation time,vigilance sedation score at the time of admission to the PACU,postoperative pain scores,remedial antiemetics,and use of analgesics were recorded.Observe the occurrence of nausea and vomiting within 0-2 h and 2-24 h of the patient.Results The HR in group D was lower than that in group R from T2 to T7(P<0.05).There was no significant difference in MAP between the two groups(P>0.05).There was no significant difference in operation time and anesthesia time between group R and group D(P>0.05).In group D,eye open time and extubation time were longer than those in group R(P<0.05).The sedation score of group OAA/S was lower than that of group R(P<0.05).In the 2 period after operation, the incidence of nausea in group D was lower than that in group R(P<0.05),and the use rate of antiemetic drugs was lower than that in group R(P<0.05),and the incidence of postoperatively vomiting in the two groups was not statistically significant(P>0.05).After 0~2 h pain VAS score, there was no significant difference between the two groups(P>0.05),at 2~24 h after operation,the score of VAS in group D was lower than that in group R,and there was no significant difference in the rate of salvage analgesia between the two groups(P>0.05). Conclusion For patients with thyroid surgery, the load of right metomomidine before induction of anesthesia was 1μg,and the maintenance amount of 0.3 ~ 0.5μg/(kg·h)could effectively reduce the symptoms of postoperative nausea and vomiting,reduce the use of antiemetic drugs and improve the postoperative analgesic effect.